采用EQ-5D测量中国急性缺血性脑卒中患者生存质量的相关性实证研究

目的:通过EQ-5D量表中EQ-5D健康描述系统和EQ-VAS(直观相似尺度)评分对急性缺血性脑卒中患者健康相关生存质量测量的相关性进行研究.方法:采用前瞻性的随机对照试验设计,对220例急性缺血性脑卒中患者从就诊第0天、第8天、出院至第90天的生存质量和健康状况,运用EQ-5D健康描述系统和EQ-VAS进行研究.结果:以EQ-5D指数得分(健康描述系统评分)和EQ-VAs得分对患者四个阶段生存质量的表达进行线性回归模型拟合,发现两者对患者生存质量的表达趋势一致;进而进行的无控制变量和有控制变量(教育程度和从事职业)的相关性分析显示两者的相关系数均较高(>0.500;P=0.000),且相关性的稳定性也较好.结论:EQ-5D健康描述系统和EQ-VAS的相关性较好,两者的配合使用适用于我国急性缺血性脑卒中患者生存质量和健康状况测量,能够反映其变化情况,也适宜做进一步的成本-效用分析.     

社区脑卒中患者生活质量的研究

目的:探讨脑卒中康复期患者的生活质量现状,并分析其影响因素,为提高患者的生活质量提供参考依据.方法:采用自行设计的一般资料、脑卒中生活质量影响因素量表(SIS 3.0)对80例缺血性脑卒中患者进行调查.结果:多元线性回归结果显示,对生活质量有明显影响的是性别、婚姻状况、收入情况等.结论:缺血性脑卒中患者恢复期生活质量相对较低,需要社区和家庭共同联合从多方面进行干预.     

辛伐他汀联合阿司匹林治疗急性缺血性脑卒中的疗效观察

目的探讨辛伐他汀联合阿司匹林治疗急性缺血性脑卒中的疗效。方法选取我院收治的急性缺血性脑卒中患者120例进行回顾性分析,随机分成观察组和对照组各60例,观察组采用辛伐他汀联合阿司匹林治疗,对照组仅采用阿司匹林治疗,观察两组在血脂各项指标、ADL 评分、ESS 评分和治疗效果上的不同。结果治疗前后两组血脂各项指标均有显著下降,且观察组下降水平显著优于对照组,存在统计学意义（P＜0.05）;治疗前后两组ADL和ESS评分均有显著变化,观察组变化显著优于对照组,存在统计学意义（P＜0.05）;观察组治疗效果明显优于对照组,存在统计学意义（P＜0.05）。结论辛伐他汀联合阿司匹林治疗急性缺血性脑卒中效果显著,能够有效降低血脂水平,改善神经功能和日常生活能力,值得临床推广。     

血清尿酸水平与急性缺血性脑卒中的预后无关

目的分析血清尿酸水平与急性缺血性脑卒中预后之间的关系。方法筛选经临床和影像学检查确诊的急性缺血性脑卒中患者233例,发病6h内采集血液样本并检测血清尿酸浓度,给予相同的急性缺血性脑卒中内科治疗处理。主要观察急性缺血性脑卒中3个月后的早期神经功能改善和功能性预后。结果早期神经功能改善者和无改善者平均血清尿酸浓度无明显差异(P>0.05)。功能性预后良好和预后较差患者血清尿酸水平之间存在统计学临界差异(P=0.05)。调整混杂因素后,高血清尿酸水平既与早期神经功能改善无关,也与功能性预后良好无关(P>0.05)。结论血清尿酸水平与缺血性脑卒中后5d的早期神经功能改善和3个月后的功能性预后良好无关。     

采用EQ-5D测量日本Ⅱ型糖尿病病人健康相关生存质量

目的:采用日文版欧洲生命质量量表(EQ-5D)测量糖尿病病人健康相关生存质量(HRQL),考察病人临床状况与健康状况(health status)之间的关系。方法:1998年11月17日至12月24日,对到日本琦玉县(Saitama Prefecture)一家医院门诊的220名Ⅱ型糖尿病病人开展了该项研究。病人采用5个维度以及视觉模拟法(visual analog scale,VAS)评价了他们的健康状况。EQ- 5D积分根据病人回答的5个问题的答案,采用事先确定的日文版分值表计算。结果:没有病人回答极度严重等级的问题;有并发症的病人在活动性(mobility)和焦虑与沮丧(anxiety/ depression)两个维度回答有些问题的频率显著高于无并发症的病人(活动性:27.4%和14.4%;焦虑与沮丧:25.7%和13.5%)。有并发症病人EQ-5D平均得分为0.846(95%置信区间0.817～0.874),无并发症病人平均得分为0.884(95%置信区间0.855～0.914)。有糖尿病并发症病人与无糖尿病并发症病人的VAS得分统计学差异显著,有视网膜病变病人与无视网膜病变病人的VAS得分有显著差异。结论:本研究的发现提示我们重视糖尿病病人健康状况测量的价值,因为这使我们能比较全面地评价病人的健康情况,并且为病人主观症状与实验室检查数据增加另一个维度的资料。     

静脉注射硫酸镁对急性缺血性脑卒中患者的临床疗效

目的评价静脉注射硫酸镁对急性缺血性脑卒中的临床疗效。方法将112例筛选患者随机分成两组,治疗组给予静脉注射硫酸镁,对照组接受同体积0.9%氯化钠注射液,观察90d后Rankin评分和NIHSS评分。结果治疗90 d后,治疗组NIHSS评分和Rankin评分明显低于对照组(P<0.05)。脑卒中症状发作2~5 h内接受镁治疗的患者90 d后NIHSS评分明显低于6~12 h内接受治疗的患者(P<0.05)。结论硫酸镁可作为治疗急性缺血性脑卒中安全和有效的神经保护剂。     

基于真实世界氢溴酸樟柳碱注射液治疗急性缺血性脑卒中的有效性及药物经济学评价

目的评价氢溴酸樟柳碱注射液治疗急性缺血性脑卒中的有效性和经济性,为临床治疗急性缺血性脑卒中及政府决策提供医学依据。方法本研究为真实世界的回顾性队列研究,采用分层随机抽样的方法,选择2018年2月至2020年7月,全国31家医院2298例急性缺血性脑卒中住院患者为研究对象,其中暴露组和非暴露组各1149例。选择美国国立卫生研究院卒中量表(NIHSS)评分和改良Rankin量表(m RS)评分为有效性评价指标。采用成本-效果和成本-效用分析方法,对暴露组采用常规治疗基础上加用氢溴酸樟柳碱注射液和非暴露组采用常规方式治疗急性缺血性脑卒中的经济性进行比较。结果暴露组较非暴露组NIHSS评分多降低0.34分,差异有统计学意义(P<0.05);暴露组较非暴露组m RS评分≥2的比例降低多近10%,差异有统计学意义(P<0.05)。暴露组较非暴露组,每降低1个百分点的残障比例,增量成本不足300元。暴露组1年内获得的QALYs为0.1024年,高于非暴露组的0.0813年,差异有统计学意义(P<0.05)。暴露组人均每多获得1个QALY的成本低于世界卫生组织(WHO)推荐阈值。敏感性分析支持结果的稳健性。结论氢溴酸樟柳碱注射液可有效改善急性缺血性脑卒中患者的神经功能,降低残障程度,提高生命质量,药物经济学优势明显。     

中国城乡居民健康相关生存质量研究

本文使用中国城乡居民健康调查数据,通过EQ-5D来衡量中国城乡居民健康相关生存质量。研究发现城市居民的EQ-VAS得分为83.73,有16.80%在任一维度上存在着问题,农村居民的EQ-VAS得分为79.74,有23.99%在任一维度上存在着问题;城市居民的总体健康相关生存质量要好于农村居民。城市居民和农村居民均在疼痛或不舒服、焦虑或抑郁两个维度上存在较多问题。城市居民和农村居民在以不同社会人口学变量代表的生存质量上表现得较为一致,但农村已婚却分居和无业的居民与城市相比生存质量显著较差。为提高中国城乡居民的健康状况,政策制定者应根据城市居民和农村居民在各维度和各社会人口学变量上的不同特点制定有针对性的政策措施。     

健康教育对血液透析患者生存质量的影响

目的探讨健康教育对血液透析患者生存质量的影响。方法抽取本中心新加入规律血液透析患者共52例,随机分成两组,观察组和对照组各26例。对照组进行常规护理;观察组在对照组基础上实施健康教育护理干预,随访观察12个月后,对比两组患者的营养状况、心理情绪、社会角色、运动等生活质量相关指标的变化。结果观察组接受系统的健康教育后营养状况、心理健康、社会角色等各项相关生存质量有明显改善,差异均有统计学意义（均P〈0.05）。结论全面系统的健康教育,可明显提高规律血液透析患者的生存质量。     

58例急性脑卒中合并糖尿病患者的临床特点分析

目的对急性脑卒中合并糖尿病患者的临床特点进行分析探讨。方法随机抽取我院收治的合并有糖尿病的急性脑卒中临床患者58例为观察组,并另抽取同期非合并糖尿病急性脑卒中患者60例为对照组。对两组患者临床资料进行对比分析。结果观察组患者并发症发生率高于对照组,且差异具有统计学意义(P<0.05)。结论对于脑卒中患者而言,合并糖尿病会使疾病危险性增加,使患者病情加重,临床应给予重视。     

采用EQ-5D评估2型糖尿病患者的生活质量及影响因素研究

目的：采用EuroQol五维调查问卷表（EQ-5D）对2型糖尿病患者健康相关的生活质量进行评价,并分析其主要影响因素,探讨健康状况发展与生活质量下降的关系。方法：采用EQ-5D问卷及访问,对南京大学附属南京鼓楼医院内分泌门诊256例2型糖尿病患者生活质量和健康状况进行研究。结果全体患者EQ-5D分值平均0．790±0．158。理想控制的患者组平均值0．836（0．810～0．861;95％CI）,良好控制和控制差的组的分值分别相当于理想患者的92．2％、84．8％。出现一种或多种并发症的患者分值0．692（0．667～0．717．95％CI）,未出现并发症的患者提高到0．863（0．842～0．883,95％CI）。各种并发症的发生发展与血糖控制情况对生活质量影响程度最强。结论：EQ-5D量表适用于中国2型糖尿病患者健康状况测量,适宜成本-效果分析研究。血糖控制不理想和各并发症的发生发展是患者生活质量下降的主要影响因素。     

Economic and quality of life burden of anemia on patients with CKD on dialysis: a systematic review

Abstract

Aims: The overall cost and health-related quality of life (HRQoL) associated with current treatments for chronic kidney disease (CKD)-related anemia are not well characterized. A systematic literature review (SLR) was conducted on the costs and HRQoL associated with current treatments for CKD-related anemia among dialysis-dependent (DD) patients.

Materials and methods: The authors searched the Cochrane Library, MEDLINE, EMBASE, NHS EED, and NHS HTA for English-language publications. Original studies published between January 1, 2000 and March 17, 2017 meeting the following criteria were included: adult population; study focus was CKD-related anemia; included results on patients receiving iron supplementation, red blood cell transfusion, or erythropoiesis stimulating agents (ESAs); reported results on HRQoL and/or costs. Studies which included patients with DD-CKD, did not directly compare different treatments, and had designs relevant to the objective were retained. HRQoL and cost outcomes, including healthcare resource utilization (HRU), were extracted and summarized in a narrative synthesis.

Results: A total of 1,625 publications were retrieved, 15 of which met all inclusion criteria. All identified studies included ESAs as a treatment of interest. Two randomized controlled trials reported that ESA treatment improves HRQoL relative to placebo. Across eight studies comparing HRQoL of patients achieving high vs low hemoglobin (Hb) targets, aiming for higher Hb targets with ESAs generally led to modest HRQoL improvements. Two studies reported that ESA-treated patients had lower costs and HRU compared to untreated patients. One study found that aiming for higher vs lower Hb targets led to reduced HRU, while two other reported that this led to a reduction in cost-effectiveness.

Limitations: Heterogeneity of study designs and outcomes; a meta-analysis could not be performed.

Conclusions: ESA-treated patients undergoing dialysis incurred lower costs, lower HRU, and had better HRQoL relative to ESA-untreated patients. However, treatment to higher Hb targets led to modest HRQoL improvements compared to lower Hb targets.     

Characteristics affecting health-related quality of life (HRQOL) in Japanese patients with reflux oesophagitis and the effect of lansoprazole on HRQOL

Abstract

Objectives: A survey of health-related quality of life (HRQOL) in the Japanese general population has suggested that HRQOL is affected by sex and age. We investigated whether there is any effect of baseline patients' characteristics on HRQOL of patients with reflux oesophagitis (RE), and its changes with lansoprazole (LPZ) treatment.

Research design and methods: This was a post hoc analysis of an open-label, multicentre, post-marketing, observational study which investigated the effect of LPZ (15 or 30 mg/day for 8 weeks) on HRQOL in patients with RE. At baseline, and after 4 and 8 weeks of treatment, HRQOL was assessed using a Japanese version of the 8-item Short-Form Health Survey (SF-8) and a newly-developed RE-specific questionnaire (RESQ). Stratified analysis of changes in HRQOL scores according to baseline patient characteristics such as sex, age and baseline severity of typical RE symptoms was performed.

Results: A total of 8,757 patients were included in the efficacy analysis. At baseline, physical component summary scores from the SF-8 were lower in older patients (≥60 years) than in younger patients (<60 years), and mental component summary scores were lower in younger patients than in older patients. These scores significantly improved after LPZ treatment regardless of sex and age. HRQOL scores were lower in patients with more severe typical RE symptoms at baseline. After LPZ treatment, HRQOL scores significantly improved to similar levels irrespective of the severity of the typical RE symptom at baseline.

Conclusions: This post hoc analysis suggests that sex, age and severity of typical RE symptoms affect HRQOL in patients with RE in Japan, and such factors do not affect the improvement of HRQOL with LPZ treatment. The present study suggests a positive impact of LPZ; however, it is difficult to estimate the degree of improvement in HRQOL that may have arisen from symptomatic relief as part of the natural history of the disease from the study. Our results may overestimate the efficacy of LPZ. Further well-controlled clinical studies are needed to confirm the efficacy of LPZ on HRQOL in patients with RE.     

Impact of the dedicated infrastructure on bus service quality: an empirical analysis

An econometric analysis is conducted to quantify the impact of different variables on the service quality of the Santiago, Chile bus system. The indicators tested as measures of service quality are the average bus speed, the bus trip time coefficient of variation and the bus headway coefficient of variation. The analysis uses peak hour data obtained for all the routes served by the system’s various concessionaire operators. A separate multiple linear regression model is estimated for each indicator, with the latter as the explained variable. The main explanatory variables are a series of design factors representing different types of dedicated route infrastructure and the incorporation in some routes of segments of urban motorway. The results of the models show that the existence of dedicated bus route infrastructure positively impacts all three service quality indicators. The use of motorway segments in particular has a major positive effect on average speed. The model estimates also reveal that the main explanatory factor in headway variability at the end of a route is the headway variability at the start of it, the latter factor determined by operator management decisions regarding bus despatches.     

Health-related quality of life,work productivity and costs related to patients with inflammatory bowel disease in Austria

Abstract

Objective

Inflammatory-Bowel-Disease (IBD) is a lifelong illness with significant impact on health-related quality of life (HRQoL). The disease-burden causes work productivity impairment, such as sick-leave and restriction of leisure time activities. From a societal perspective, productivity loss often contributes significantly to the total costs. The aim of the study is to analyze the impact of disease-burden on work productivity, daily activities, and HRQoL.     

Final development and validation of the BOMET-QoL questionnaire for assessing quality of life in patients with malignant bone disease due to neoplasia

SUMMARY

This paper describes the final development and validation of the BOMET-QoL questionnaire for assessing health-related quality of life (HRQoL) in patients with malignant bone disease due to neoplasia (MBDN).

An observational prospective study was conducted of 263 patients with MBDN. Sociodemographic and clinical variables, Eastern Cooperative Oncology Group (ECOG) Performance Scale Index and Pain Management Index (PMI) were gathered. Patients completed the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and BOMET-QoL questionnaires and the perception of general health status. Both questionnaires were completed again 15 days after the baseline visit by 98 clinically stable patients (Group A), and 3 months and 6 months after the baseline visit by 165 clinically unstable patients (Group B). Prior to validation of the BOMETQoL questionnaire, a factor analysis and psychometric selection of the original items was developed by means of Rasch analysis.

The BOMET-QoL questionnaire consisting of 25 items was reduced to an integrated version of 10 items. Scores on the BOMET-QoL-10 questionnaire were shown to be related to the presence, number and duration of irruptive pain crises, the PMI and the ECOG index (p<0.001), and with changes in the perception of general health status and ECOG index (p<0.01). The internal consistency of the questionnaire and the intraclass correlation coefficient (ICC) were high (Cronbach's α=0.93; ICC =0.97). BOMET-QoL-10 is an easy to manage and valid questionnaire in clinical practice conditions.     

中国大城市低碳发展水平评估与实证分析

大城市既是碳排放的主要载体,也是实现国家和区域低碳发展的重要着力点。本文借鉴DPSIR模型构建了低碳城市综合评价指标体系,采用Spearman秩系数和主成分分析方法,对中国35个重点城市的低碳发展水平进行了实证分析。分析结果表明,我国城市低碳发展水平总体上呈现跃迁的良好势头,但具有明显的地域特征。城市的经济发展水平和资源禀赋及利用仍然是决定现阶段中国城市低碳发展能否顺利实施的重要物质基础和影响因素。     

中国农产品贸易流量及潜力测算——基于引力模型的实证分析

本文利用国际贸易引力模型(Gravity Model)对中国农产品贸易流量的决定因素及贸易潜力进行了实证分析.研究结果表明:优惠贸易安排对农产品贸易有明显的促进作用;农产品贸易国家之间的人均收入差距越大,农产品贸易越小.中国与墨西哥、俄罗斯、印度等发展中国家的农产品"贸易不足",潜力巨大;与发达国家或地区中的欧盟、加拿大和澳大利亚的贸易潜力有待开发.